不同双联抗血小板方案对急性冠状动脉综合征合并2型糖尿病患者经皮冠状动脉介入术后残余血小板高反应性及主要心血管不良事件与出血事件风险的影响  

Influence of different kinds of dual-antiplatelet regimen on platelet reactivity,major adverse cardiovascular events and bleeding events after percutaneous coronary intervention of patients with acute coronary syndrome complicated with type 2 diabetes meli

作　　者：马素霞[1] 吴慧颖[1] 

机构地区：[1]商丘市第一人民医院心内二科,476100

出　　处：《心肺血管病杂志》2018年第2期91-94,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨阿司匹林分别联合氯吡格雷与替格瑞洛对急性冠状动脉综合征(ACS)合并2型糖尿病(T2DM)患者经皮冠状动脉介入(PCI)术后残余血小板高反应性、主要心血管不良事件(MACE)及出血事件风险的影响。方法:研究对象选取ACS合并T2DM患者共120例,根据抗血小板方案不同分为对照组(63例)和观察组(57例),在阿司匹林基础上分别加用氯吡格雷与替格瑞洛治疗,比较两组患者残余血小板高反应性发生率,术后24h花生四烯酸途径(AA)抑制率、二磷酸腺苷(ADP)抑制率、二磷酸腺苷诱导最大血块强度(MA-ADP)水平,全因死亡率,MACE发生率及出血事件发生率。结果:观察组患者残余血小板高反应性发生率显著低于对照组(P<0.05);观察组患者术后24h血栓弹力图指标水平均显著优于对照组(P<0.05);两组患者全因死亡率、脑卒中、再发心肌梗死及心源性猝死发生率比较,差异无统计学意义;观察组患者支架内血栓发生率显著低于对照组(P<0.05);两组患者出血事件发生率比较,差异无统计学意义。结论:相较于氯吡格雷,阿司匹林联合替格瑞洛用于ACS合并T2DM患者可显著降低残余血小板高反应性,提高抗血小板效果,并有助于预防支架内血栓发生。Objective： To investigate the influence of aspirin separately combined with clopidogrel and ticagrelor on platelet reactivity,MACE and bleeding events after PCI of patients with ACS complicated with T2 DM. Methods： 120 patients with ACS complicated with T2 DM were chosen and randomly divided into 2 groups including control group（ 63 patients） with clopidogrel and observation group（ 57 patients） with ticagrelor on the basis of aspirin; and the high platelet reactivity incidence,inhibitory rate of AA and ADP and MA-ADP in 24 h after operation,all-cause mortality,the incidence of MACE and bleeding events of both groups were compared. Results： The high platelet reactivity incidence of observation group were significant lower than control group（ P 〈0. 05）. The TEG index in 24 h after operation of observation group were significant higher than control group（ P〈 0. 05）. The incidence of subacute thrombosis of observation group were significant lower than control group（ P 〈0. 05）. There was no significant difference in the all-cause mortality and the incidence of stroke,recurrent myocardial infarction and sudden cardiac death between 2 groups. There was no significant difference in the incidence of bleeding events between 2 groups. Conclusion： Compared with clopidogrel,ticagrelor combined with aspirin in the treatment of patients with ACS complicated with T2 DM can efficiently reduce the high platelet reactivity,improve the anti-platelet effects and prevent the substent thrombosis.

关 键 词：氯吡格雷 替格瑞洛 抗血小板 急性冠状动脉综合症 2型糖尿病 

分 类 号：R54[医药卫生—心血管疾病]